Bone Metastases Detection in Patients with Breast Cancer: Does Bone Scintigraphy Add Information to PET/CT?

Joana Cristo Santos, Miguel Henriques Abreu, Miriam Seoane Santos, Hugo Duarte, Tiago Alpoim, Inês Próspero, Susana Sousa, Pedro Henriques Abreu, Joana Cristo Santos, Miguel Henriques Abreu, Miriam Seoane Santos, Hugo Duarte, Tiago Alpoim, Inês Próspero, Susana Sousa, Pedro Henriques Abreu

Abstract

Background: Positron emission tomography/computed tomography (PET/CT) has become in recent years a tool for breast cancer (BC) staging. However, its accuracy to detect bone metastases is classically considered inferior to bone scintigraphy (BS). The purpose of this work is to compare the effectiveness of bone metastases detection between PET/CT and BS.

Materials and methods: Prospective study of 410 female patients treated in a Comprehensive Cancer Center between 2014 and 2020 that performed PET/CT and BS for staging purposes. The image analysis was performed by 2 senior nuclear medicine physicians. The comparison was performed based on accuracy, sensitivity, and specificity on a patient and anatomical region level and was assessed using McNemar's Test. An average ROC was calculated for the anatomical region analysis.

Results: PET/CT presented higher values of accuracy and sensitivity (98.0% and 93.83%), surpassing BS (95.61% and 81.48%) in detecting bone disease. There was a significant difference in favor of PET/CT (sensitivity 93.83% vs. 81.48%), however, there is no significant difference in eliminating false positives (specificity 99.09% vs. 99.09%). PET/CT presented the highest accuracy and sensitivity values for most of the bone segments, only surpassed by BS for the cranium. There was a significant difference in favor of PET/CT in the upper limb, spine, thorax (sternum) and lower limb (pelvis and sacrum), and in favor of BS in the cranium. The ROC showed that PET/CT has a higher sensitivity and consistency across the bone segments.

Conclusion: With the correct imaging protocol, PET/CT does not require BS for patients with BC staging.

Conflict of interest statement

The authors indicated no financial relationships.

© The Author(s) 2023. Published by Oxford University Press.

Figures

Figure 1.
Figure 1.
Average ROC curves. The dots represent the values for each bone segment and the line corresponds to the average ROC curve. (a) ROC curve for PET/CT (AUC = 0.9509). (b) ROC curve for BS (AUC = 0.7969).

References

    1. Sung H, Ferlay J, Siegel RL, et al. . Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. 10.3322/caac.21660.
    1. Siegel RL, Miller KD, Fuchs HE, Jemal A.. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7-33. 10.3322/caac.21654.
    1. Weigelt B, Glas AM, Wessels LF, et al. . Gene expression profiles of primary breast tumors maintained in distant metastases. Proc Natl Acad Sci USA. 2003;100(26):15901-15905. 10.1073/pnas.2634067100.
    1. Beheshti M, Langsteger W, Rezaee A.. PET/CT in Cancer: An Interdisciplinary Approach to Individualized Imaging. Elsevier Health Sciences, 2017.
    1. Macedo F, Ladeira K, Pinho F, et al. . Bone metastases: an overview. Oncol Rev. 2017;11(1):321. 10.4081/oncol.2017.321.
    1. Bäuerle T, Semmler W.. Imaging response to systemic therapy for bone metastases. Eur Radiol. 2009;19(10):2495-2507. 10.1007/s00330-009-1443-1.
    1. O’Sullivan GJ, Carty FL, Cronin CG, Imaging of bone metastasis: an update. World J Radiol. 2015;7(8):202-211. 10.4329/wjr.v7.i8.202.
    1. Cook G, Azad G, Goh V.. Imaging bone metastases in breast cancer: staging and response assessment. J Nucl Med. 2016;57(Suppl 1):27S-33S. 10.2967/jnumed.115.157867.
    1. Coleman R, Body JJ, Aapro M, Hadji P, Herrstedt J.. Bone health in cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2014;25(Suppl 5):iii124-iii137. 10.1093/annonc/mdu103.
    1. Puglisi F, Follador A, Minisini A, et al. . Baseline staging tests after a new diagnosis of breast cancer: further evidence of their limited indications. Ann Oncol. 2005;16(2):263-266. 10.1093/annonc/mdi063.
    1. Senkus E, Kyriakides S, Ohno S, et al. . Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(Suppl 5):v8-v30. 10.1093/annonc/mdv298.
    1. Gradishar WJ, Anderson BO, Abraham J, et al. . Breast cancer, version 3.2020, NCCN Clinical Practice Guidelines in oncology. J Natl Compr Canc Netw. 2020;18(4):452-478. 10.6004/jnccn.2020.0016.
    1. Cardoso F, Paluch-Shimon S, Senkus E, et al. . 5th ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 5). Ann Oncol. 2020;31(12):1623-1649. 10.1016/j.annonc.2020.09.010.
    1. Teke F, Teke M, Inal A, et al. . Significance of hormone receptor status in comparison of 18F-FDG-PET/CT and 99mTc-MDP bone scintigraphy for evaluating bone metastases in patients with breast cancer: single center experience. Asian Pac J Cancer Prev. 2015;16(1):387-391. 10.7314/apjcp.2015.16.1.387.
    1. Kim S, Lee W.. Does McNemar’s test compare the sensitivities and specificities of two diagnostic tests? Stat Methods Med Res. 2017;26(1):142-154. 10.1177/0962280214541852.
    1. McNemar Q. Note on the sampling error of the difference between correlated proportions or percentages. Psychometrika. 1947;12(2):153-157. 10.1007/BF02295996.
    1. Amin MB, Edge S, Greene Fet al. . AJCC Cancer Staging Manual. 8th edition, Springer International Publishing: American Joint Commission on Cancer, 2017.
    1. Cardoso F, Kyriakides S, Ohno S, et al. . Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2019;30(8):1194-1220. 10.1093/anonc/mdz173.
    1. Liede A, Jerzak KJ, Hernandez RK, et al. . The incidence of bone metastasis after early-stage breast cancer in Canada. Breast Cancer Res Treat. 2016;156(3):587-595. 10.1007/s10549-016-3782-3.
    1. Jung SY, Rosenzweig M, Sereika SM, et al. . Factors associated with mortality after breast cancer metastasis. Cancer Causes Control. 2012;23(1):103-112. 10.1007/s10552-011-9859-8.
    1. Liu T, Cheng T, Xu W, et al. . A meta-analysis of 18 FDG-PET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with breast cancer. Skeletal Radiol. 2011;40(5):523-531. 10.1007/s00256-010-0963-8.
    1. Rybak L, Rosenthal D.. Radiological imaging for the diagnosis of bone metastases. Q J Nucl Med. 2001;45(1):53-64.
    1. Bitencourt AGV, Andrade WP, Cunha RR, et al. . Detection of distant metastases in patients with locally advanced breast cancer: role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and conventional imaging with computed tomography scans. Radiologia Brasileira. 2017;50(4):211-215. 10.1590/0100-3984.2015-0232.
    1. Park S, Yoon JK, Lee SJ, et al. . Prognostic utility of FDG PET/CT and bone scintigraphy in breast cancer patients with bone-only metastasis. Medicine (Baltimore). 2017;96(50):e8985. 10.1097/MD.0000000000008985.
    1. Hahn S, Heusner T, Kümmel S, et al. . Comparison of FDG-PET/CT and bone scintigraphy for detection of bone metastases in breast cancer. Acta Radiol. 2011;52(9):1009-1014. 10.1258/ar.2011.100507.
    1. Bruckmann NM, Kirchner J, Umutlu L, et al. . Prospective comparison of the diagnostic accuracy of 18F-FDG PET/MRI, MRI, CT, and bone scintigraphy for the detection of bone metastases in the initial staging of primary breast cancer patients. Eur Radiol. 2021;31(11):8714-8724. 10.1007/s00330-021-07956-0.
    1. Heusner T, Gölitz P, Hamami M, et al. . “One-stop-shop” staging: Should we prefer FDG-PET/CT or MRI for the detection of bone metastases? Eur J Radiol. 2011;78(3):430-435. 10.1016/j.ejrad.2009.10.031.
    1. Jambor I, Kuisma A, Ramadan S, et al. . Prospective evaluation of planar bone scintigraphy, SPECT, SPECT/CT, 18F-NaF PET/CT and whole body 1.5 T MRI, including DWI, for the detection of bone metastases in high risk breast and prostate cancer patients: SKELETA clinical trial. Acta Oncol. 2016;55(1):59-67. 10.3109/0284186X.2015.1027411.
    1. Minamimoto R, Loening A, Jamali M, et al. . Prospective comparison of 99mTc-MDP scintigraphy, combined 18F-NaF and 18F-FDG PET/CT, and whole-body MRI in patients with breast and prostate cancer. J Nucl Med. 2015;56(12):1862-1868. 10.2967/jnumed.115.162610.
    1. Micco RD, Santurro L, Gasparri ML, et al. . PET/MRI for staging the axilla in breast cancer: current evidence and the rationale for SNB vs. PET/MRI trials. Cancers. 2021;13(14):3571. 10.3390/cancers13143571.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner